Rising health costs have seen increased emphasis on cost containment. Outpatient follow-up after total joint arthroplasty is one such accumulating cost. Enthusiastic recent media interest in failing implants and unacceptable waiting lists adds further interest to the area.

We wished to determine the current post-operative follow-up practices and views of New Zealand Orthopaedic Surgeons. A postal survey was sent to all New Zealand Orthopaedic Surgeons.

The response rate was 83% (131/158). There was wide variation in routine practice and beliefs. For cemented THJRs, 13% of surgeons routinely saw their patients for less than one year, 38% followed their patients for less than five years and 53% continued to see patients indefinitely. Follow-up for uncemented/hybrid prostheses was higher: 8% for < one year, 29% for < 5 years and 59% indefinitely. A system of periodically re-calling patients for x-rays without necessarily seeing them is used by 20% of surgeons.

The most frequent reasons given for follow-up were the detection of osteolysis, wear, loosening and patient symptoms.

Similar figures for total and uni-compartmental knee replacements were reported.

Almost a third of surgeons reported that they were unable to follow-up their patients as they would like to because of resource limitations within the public health sector. 44% believed that future changes in medico-legal expectations will necessitate longer follow-up of patients.

This survey demonstrates wide variation in practice. Higher follow-up rates for un-cemented/hybrid prostheses may reflect uncertainty about the long-term results. There is concern amongst surgeons that their ability to follow-up patients within the public health-care sector is constrained by cost. Periodic questionnaire and x-ray assessment was suggested by many as a possible alternative for long-term follow-up of selected patients. Few surgeons are however presently using such a system. We propose a standard of care.

Aim: The S-ROM femoral component is a versatile modular prosthesis that can be adapted to the majority of complex hip revision situations. The purpose of this study is to review the results of this prosthesis with a minimum follow-up of two years.

Method: Fifty-six consecutive revision hip arthroplasties using the S-ROM femoral component were performed in 49 patients by the senior author. The patients with segmental femoral allografts were excluded. A retrospective chart review and radiographic analysis was performed and the pre-operative and post-operative modified Harris hip scores compared.

Results: Forty-nine patients with 56 hips were evaluated between two and seven years after revision surgery. There were 25 females and 24 males. The average age was 66.6 years (range: 44.8 to 94.6). Revision arthroplasties were performed for loose components in 36 hips, infected components in 10 hips, recurrent dislocation in three hips and for miscellaneous diagnoses in seven. The average number of previous surgical procedures on the affected hip was 2.4 (range: one to seven). The modified Harris hip score improved from a pre-operative average of 42 to a post-operative average of 73 at the most recent follow-up examination. Three patients had failed revisions at seven years (5%). One patient underwent a resection arthroplasty for infection, one patient underwent re-revision for recurrent dislocation and one patient dislocated, became infected and is on suppressive antibiotic therapy. Other complications included nine dislocations (16%), seven intra-operative fractures (13%), trochanteric irritation in five patients (9%), residual thigh pain in three patients (5%), heterotopic ossification in two patients (4%), one post-operative sciatic nerve palsy (2%) and early osteolysis in one patient (2%).

Conclusion: Short to intermediate term follow-up of the S-ROM femoral component in this group of revision patients has yielded excellent results. In terms of loosening and osteolysis these results are comparable to primary hip arthroplasty using the S-ROM prosthesis.